Mastectomy Likely Not Effective for Ovarian Cancer Survivors with BRCA Mutation

Patients with BRCA gene mutations have a significantly higher risk of developing breast and ovarian cancers. As a preventive measure, many patients undergo mastectomy or removal of the ovaries and fallopian tubes.
 
However, these surgeries may not be worth the cost for some patients with BRCA mutations who have previously had ovarian cancer, according to a new study published by the Annals of Surgical Oncology.
 
The study suggests that prophylactic mastectomy among ovarian cancer survivors with a BRCA mutation may not increase survival and is not cost-effective.
 
The authors said that their findings are significant because the National Comprehensive Cancer Network recently recommended that women with ovarian cancer receive genetic testing, regardless of familial history. Due to these guidelines, more patients are learning they have a BRCA mutation and may seek prophylactic treatment.
 
“Risk-reducing mastectomy is costly and can require many months of follow-up and recovery,” said lead author Charlotte Gamble, MD. “Our results emphasize that prophylactic mastectomy should be used selectively in women with both a BRCA mutation and a history of ovarian cancer.”
 
In the study, the authors created a statistical model that compared mastectomy to breast cancer screening, including mammogram and MRI. Included in the model were age at ovarian cancer diagnosis, time between diagnosis and mastectomy, BRCA mutation status, cancer survival rates, and treatment costs, according to the study.
 
The authors compared risk-reducing mastectomy with breast cancer screening every 6 months after ovarian cancer diagnosis.
 
The investigators also assessed the treatments through the incremental cost-effectiveness ratio. Interventions where the ratio is less than $100,000 per year of life saved were considered cost-effective.
 
 The benefit of mastectomy over screening alone was observed to depend on the patient’s age at time of diagnosis and time to mastectomy.
 
For patients diagnosed at any age with BRCA 1 and 2 mutations, prophylactic mastectomy within 4 years of diagnosis was not found to be cost-effective due to limited gains in survival, according to the study.
 
For patients diagnosed at 60 years and older, survival gain was also limited with prophylactic mastectomy. The authors concluded that the procedure was not cost-effective in these patients, regardless of time since diagnosis.
 
For patients with the BRCA mutations who were diagnosed at age 40 to 50 years, prophylactic mastectomy at least 5 years after ovarian cancer diagnosis was linked to a survival benefit of 2 to 5 months compared with screening, according to the study. This treatment was found to be cost-effective, the authors noted.
 
“Our study provides clarity on how a woman’s age and timing of a risk-reducing mastectomy after an ovarian cancer diagnosis impact the benefit of this procedure,” Dr Gamble said. “Within the first 5 years, nobody benefitted from risk-reducing mastectomy and after that threshold, survival gains were seen mostly in the youngest, healthiest ovarian cancer patients.”
 
These results suggest that prophylactic mastectomy may not be the best treatment route for a majority of ovarian cancer survivors with BRCA mutations.
 
“There is no right or wrong answer on how to manage breast cancer risk in this unique population,” said senior author Rachel Greenup, MD. “However, we hope that our findings provide guidance to women and their doctors deciding if and when prophylactic mastectomy is beneficial following ovarian cancer treatment.”


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